摘要
目的探讨EGFR突变阳性的晚期肺腺癌患者经EGFR-TKI诱导治疗后,以EGFR-TKI联合胸部放疗作为维持治疗的疗效和安全性。方法收集陆军军医大学西南医院2012年1月至2019年7月收治的EGFR突变阳性、接受一线EGFR-TKI治疗并达到疾病稳定的晚期肺腺癌患者的临床资料,EGFR-TKI诱导治疗达疾病稳定后联合胸部放疗维持为联合治疗组,单药TKI维持为单药治疗组。对两组患者的无进展生存期(PFS)、缓解持续时间(DOR)、客观缓解率(ORR)、疾病控制率(DCR)和不良反应进行回顾性分析。结果共收集符合标准的患者178例,其中联合治疗组23例,单药治疗组155例,经过倾向性得分匹配(PSM)1︰1匹配后,配对成功21对。两组在临床资料基线水平一致(P>0.05),两组的中位PFS分别为19.8个月和12.3个月(P=0.000),中位DOR分别为16.5个月和9.8个月(P=0.002),ORR分别为85.7%和76.2%(P=0.687),DCR都是100%,3级及以上不良反应分别为5例(23.8%)、4例(19.0%)。两组共同的不良反应相差不大,最常见的为皮疹,分别为9例(42.8%)和10例(47.6%)。联合治疗组出现放射性肺炎11例(52.4%),其中1级10例,2级1例。结论一线EGFR-TKI诱导治疗后,EGFR-TKI联合胸部放疗维持治疗比EGFR-TKI单药维持治疗有更好的PFS获益,并且联合组安全性可耐受。
Objective To investigate the efficacy and safety of EGFR-TKI combined with thoracic radiotherapy as maintenance therapy in patients with advanced lung adenocarcinoma with positive EGFR mutation after induction therapy of EGFR-TKI.Method Collecting the clinical characteristic of patients with advanced lung adenocarcinoma with positive EGFR mutation admitted to southwest Hospital of Army Military Medical University from January 2012 to July 2019,who received first-line EGFR-TKI treatment and achieved disease stability.Patients who underwent EGFR-TKI induction therapy to achieve disease stabilization and then maintained by thoracic radiotherapy were treated as the combined treatment group,maintained with monotherapeutic TKI were treated as the monotherapy group.Progression-free survival(PFS),duration of response(DOR),objective response rate(ORR),disease control rate(DCR)and adverse reactions of two groups were analyzed retrospectively.Results A total of 178 patients met the criteria were collected,including 23 patients in the combined treatment group and 155 patients in the monotherapy group.21 pairs were matched successfully after the propensity score matching at a ratio of 1︰1,Baselines of two groups of patients were consistent(P>0.05).Median PFS was 19.8 months in the combined treatment group and 12.3 months in the monotherapy group(P=0.000).The median DOR was 16.5 months and 9.8 months,respectively(P=0.002).ORR of two group was 85.7%and 76.2%(P=0.687).DOR were 100%in both groups.Grade 3 or worse adverse reactions were 5 cases(23.8%)and 4 cases(19.0%),respectively.The common adverse reactions of the two groups were not significantly different,and the most common was rash,9(42.8%)and 10(47.6%)respectively.In the combined treatment group,there were 11 cases(52.4%)of radioactive pneumonia,including 10 cases of grade 1 and 1 case of grade 2.Conclusion After first-line EGFR-TKI induction therapy,EGFR-TKI combined with thoracic radiotherapy maintenance therapy showed better PFS benefit than EGFR-TKI single-drug maint
作者
王康
胡雪婷
罗虎
周向东
Wang Kang;Hu Xueting;Luo Hu;Zhou Xiangdong(Institute of Respiratory Diseases,Department of Respiratory,Xinan Hospital,Army Military Medical University,Chongqing 400038,China)
出处
《中华肺部疾病杂志（电子版）》
CAS
2021年第1期17-23,共7页
Chinese Journal of Lung Diseases(Electronic Edition)
基金
国家自然青年基金资助项目(81702293)
校临床科研重点项目(2018XLC2002)
校临床科研人才专项(2019XLC1002)。
关键词
肺腺癌
EGFR酪氨酸激酶抑制剂
胸部放疗
维持治疗
倾向性得分匹配
Adenocarcinoma of lung
EGFR tyrosine kinase inhibitors
Thoracic radiotherapy
Maintenance therapy
Propensity score matching
